Community Roots Program Application
Bayan Roots is committed to making health care more accessible. We provide services as an ongoing form of self-care maintenance through stress management, injury prevention, and rehabilitation. These services are not meant to be experienced as an infrequent luxury. Through our Community Roots program we hope to make services available to low income people who would not otherwise be able to afford or have access to them.

Details:

1. There are a limited number of Community Roots clients that will be accepted into the program.

2. People accepted into the program will be briefed on guidelines, goals, commitment, pricing options, and frequency of services. Ideally, folks will receive services on a monthly basis or more.

3. The program term is 6 months for 60 minute massage only. At the end of 6 months, people may request to continue and to determine if the terms continue to be a good fit for both clients and Bayan Roots.

4. At any time, Bayan Roots may make adjustments or terminate the program for any reason.

5. If participants no longer wish to participate in the Community Roots program, please give staff two weeks notice.
Name: *
Your answer
Birthdate: *
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Nickname (if any):
Your answer
Gender Pronoun: *
Your answer
Email: *
Your answer
Phone #: *
Your answer
Do you identify as any of the following? (Please check all that apply and feel free to write in additional information): *
Required
Are you currently employed or have access to work/income? If yes what do you do? Where? *
Your answer
Do you have any dependents (people depending on your source of income like children, seniors, family members... etc.)? *
Your answer
How long have you and/or your family been living in Oakland? *
Your answer
Is there anything else you'd like us to know about you? Any other hardships you might be facing? *
Your answer
How often are you interested in coming in to receive bodywork and what days are you available? *
Your answer
Our regular rate for a 60 min massage is $99. What rate for 60 minutes would feel sustainable and doable for you at this time? *
What type of modality to you prefer? *
Applicant's Signature: *
Your answer
Today's date: *
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